European Journal of Sport Science

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Does a water-training macrocycle really create

imbalances in swimmers' shoulder rotator
muscles?

Nuno Batalha, José Marmeleira, Nuno Garrido & António J. Silva

To cite this article: Nuno Batalha, José Marmeleira, Nuno Garrido & António J. Silva (2015) Does
a water-training macrocycle really create imbalances in swimmers' shoulder rotator muscles?,
European Journal of Sport Science, 15:2, 167-172, DOI: 10.1080/17461391.2014.908957

To link to this article: https://doi.org/10.1080/17461391.2014.908957

Published online: 23 Apr 2014.

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European Journal of Sport Science, 2015
Vol. 15, No. 2, 167–172, http://dx.doi.org/10.1080/17461391.2014.908957

ORIGINAL ARTICLE

Does a water-training macrocycle really create imbalances in

swimmers’ shoulder rotator muscles?

NUNO BATALHA1, JOSÉ MARMELEIRA1, NUNO GARRIDO2, & ANTÓNIO J. SILVA2

1
Research Centre of Sports, Health and Human Development, Department of Sport and Health, University of Évora, Évora,
Portugal, 2Research Centre of Sports, Health and Human Development, University of Trás-os-Montes and Alto Douro, Vila
Real, Portugal

Abstract
The continuous execution of swimming techniques may cause muscle imbalances in shoulder rotators leading to injury.
However, there is a lack of published research studies on this topic. The aim of this study was to analyze the influence of a
competitive swim period on the shoulder rotator–cuff balance in young swimmers. A randomized controlled pretest–posttest
design was used, with two measurements performed during the first macrocycle of the swimming season (baseline and
16 weeks). Twenty-seven young male swimmers (experimental group) and 22 male students who were not involved in swim
training (control group) with the same characteristics were evaluated. Peak torque of shoulder internal and external rotators
was assessed. Concentric action at 1.04 rad s−1 (3 repetitions) and 3.14 rad s−1 (20 repetitions) was measured using an
isokinetic dynamometer (Biodex System 3). External/internal rotators strength ratios were also obtained. For both
protocols, there were significant training effects on internal rotator strength and external/internal rotator ratios (p ≤ .05).
This trend was the same for both shoulders. Within-group analysis showed significant changes from baseline to 16 weeks for
internal rotators strength and unilateral ratios of the experimental group. Swimmers’ internal rotator strength levels
increased significantly. In contrast, a significant decrease of the unilateral ratios was observed. Findings suggest that a
competitive swim macrocycle leads to an increase in muscular imbalances in the shoulder rotators of young competitive
swimmers. Swimming coaches should consider implementing a compensatory strength-training program.

Keywords: Swimming, isokinetic strength, muscle balance, shoulder rotators

Introduction the specific case of the shoulder joint, the unilateral

Competitive swimming is considered an endurance
sport, characterized by cyclical, alternating or simul-
taneous movements, in which the shoulder complex
plays an important role (Kluemper & Hazelrigg,
2006). Competitive swimmers commonly acquire
chronic upper extremity overuse pathologies (Ramsi,
Swanik, Swanik, Straub, & Maltacola, 2004). Most
of these injures have been related to the integrity of
shoulder rotator musculature, which plays a critical
role in providing stability and mobility to the shoul-
der joint (Wilk & Arrigo, 1993). For this reason, it
is important to characterize rotator–cuff muscle
strength and balance in overhead athletes, in order
to recognize which are at risk in terms of developing
shoulder pain and overuse injuries.
With the objective of characterizing the propor-
tional relationship between muscle groups, and in
external rotation/internal rotation ratio (ER/IR ratio)
is commonly used (Ellenbecker & Roetert, 2003).
There is still some controversy regarding the appro-
priate strength ratios for competitive overhead ath-
letes. However, a few studies have pointed to the
normative values of unilateral strength ratios in
overhead activities as being between 66% and 75%
(Cingel, Kleinrensinkb, Mulderc, Bied, & Kuiperse,
2007; Ellenbecker & Davies, 2000; Ellenbecker &
Roetert, 2003). Other cross-sectional studies asses-
sing swimmers have produced contradictory data
regarding the characterization of shoulder rotator
muscle balance. Some studies have found reduced
shoulder rotator ratios, which are muscle imbal-
ances, ranging from 39.12 ± 7.82% in the dominant
shoulder to 38.04 ± 8.04% in the non-dominant
shoulder (Gozlan et al., 2006) and from 53.26 ±
8.42% in the dominant shoulder to 65.90 ± 9.33%

Correspondence: Nuno M. Batalha, Department of Sport and Health, University of Évora, R. Reguengos de Monsaraz, No. 14, 7000-727
Évora, Portugal. E-mail: nmpba@uevora.pt

© 2014 European College of Sport Science

168 N. Batalha et al.
in the non-dominant shoulder (Olivier, Quintin, &
Rogez, 2008). Other studies report higher ratios
(70 ± 9% to 71 ± 10% in the dominant and non-
dominant shoulders, respectively; Beach, Whitney, &
Dickoff-Hoffman, 1992).
The successful prevention of shoulder injuries in
swimmers can be achieved by establishing proper
muscular balance (Johnson, Gauvin, & Fredericson,
2003). In fact, there seems to be a correlation
between shoulder rotators imbalance and injuries.
Warner, Micheli, Arslanian, Kennedy, and Kennedy
(1990), after comparing the strength tests of normal
shoulders with those with impingement and those
with instability, suggested a relative weakness in the
external rotator of the impingement group.
The implication of the external rotator weakness for
the development of shoulder pain in swimmers was
also highlighted by Beach et al. (1992). In another
longitudinal study, the authors have associated low
baseline unilateral ratios in baseball pitchers (evalua-
tions in pre-season) with future injuries in the
shoulder joint (Byram et al., 2010).
There are some evidences to suggest that the
performance of swimming techniques may cause
muscle imbalances in the shoulder rotators (Yanai
& Hay, 2000). Based on biomechanical evaluations,
some studies have found that the internal rotator
muscles are stronger in swimmers because of the
repetitive concentric contractions required during
swim strokes (Johnson et al., 2003; Swanik, Swanik,
Lephart, & Huxel, 2002; Yanai & Hay, 2000).
However, there is a gap in the literature on this
subject. To the best of our knowledge, only one
longitudinal study has sought to confirm this. Ramsi
et al. (2004), found significant differences in unilat-
eral ratios after 12 weeks of aquatic training, partially
confirming the assumption that an exclusive water-
training period disproportionately increases internal
rotator strength in comparison with their antago-
nists. Thus, there is evidence to support the import-
ance of evaluating changes in shoulder rotators
strength over the course of a swim period.
Therefore, we propose the hypothesis that the
realization of an exclusive aquatic training period
influences the shoulder rotator strength and balance.
The aim of this study is therefore to analyze the
influence of a swim training period (first macrocycle
of the swimming season) on shoulder rotator–cuff
balance in young competitive swimmers.
Methods
Subjects
Two groups were selected: (1) an experimental
group comprising 27 male Portuguese national-level
swimmers (age: 14.48 ± 0.50 years, height: 168.85 ±
7.91 cm, weight: 60.57 ± 5.29 kg, training per week:
6.75 ± 0.86 sessions, training time per day: 126 ±
26.39 minutes) and (2) a control group comprising
22 male students not engaged in swimming (age:
14.64 ± 0.49 years, height: 168.52 ± 5.35 cm,
weight: 61.13 ± 10.23 kg).
For swimmers in the experimental group the
following inclusion criteria were used: (1) no clinical
history of upper limb disorders; (2) be aged between
14 and 15 years; (3) minimum of 8 hours’ training
per week; and (4) compete at the national level. The
following inclusion criteria were applied to control
group: (1) be aged between 14 and 15 years; (2) not
having participated in organized sports during the
last year; and (3) no clinical history of shoulder
disorders. The main goals of the study were
explained to all the participants and their legal
guardians, who signed a consent form. All proce-
dures were approved by the ethics committee of the
seeding institution (proceeding 09002/2008) and
were in accordance with the Helsinki declaration
of 1975.
Procedures
A repeated-measures design was implemented with
two measurements being performed during the
swimming season, pre-season (0-week) and at the
end of the first macrocycle (16-week). Internal and
external rotator–cuff isokinetic strength data were
collected during concentric actions performed using
an isokinetic dynamometer (Biodex System 3,
Biodex Corp., Shirley, NY, USA). Standardized
protocols were followed. The arms were placed at
90° of abduction and 90° of elbow flexion in the
scapular plane, as proposed elsewhere (Julienne,
Gauthier, Moussay, & Davenne, 2007; Tyler,
Nahow, Nicholas, & McHugh, 2005). Subjects
were strapped to the seat of the dynamometer so
that the shoulder axis coincided with the axis of the
dynamometer. At the start of each test, subjects were
asked to relax their shoulder so that passive determi-
nations of the effects of gravity on the limb could be
determined.
Each subject reported to our laboratory 1 week
prior to pre-season testing for familiarization with
equipment and procedures. One week following
familiarization, after a 15-minute warm-up (articular
mobilization and stretching), peak torque was
recorded during 3 repetitions at 1.04 rad s−1 and
20 repetitions at 3.14 rad s−1. A 1.04 rad s−1 speed
was first performed for each extremity, followed by
3.14 rad s−1 speed. Two practice repetitions were
performed for each speed.
Standardized verbal instructions and encourage-
ment were given to all participants in both tests and a
2-minute resting period was allowed between each
 Shoulder rotator balance in young swimmers 169

speed test. Testing started with the arm in full IR
and was performed with a range of motion of 0–90°
(in accordance with the manufacturer’s recommen-
dations for ensuring that identical ranges of motion
were tested bilaterally and during follow-up testing).
All post-testing procedures were exactly the same.
To analyze the strength balance of shoulder rota-
tors, unilateral ratios were calculated using equation 1
(Cingel et al., 2007):
ðExternal rotation peak torque/rotation peak torqueÞ  100
ð1Þ
To verify whether there would be different matura-
tional states for both groups, the percentage of
predicted mature height, based on the Khamis and
Roche’s (1994) method, was measured. This indic-
ator is given as the percentage of predicted mature
height already achieved at the time of evaluation and
was assessed during both evaluation periods.
Statistical analysis
The Kolmogorov–Smirnov normality test, applying
Lilliefors correction was initially used to assess data
normality. Differences in baseline characteristics
between groups were compared with an independent
sample t-test. The training effects within and
between groups were evaluated using analyses of
variance for repeated measures, adjusted to the
baseline and maturation values used as covariates
(analysis of covariance), with Bonferroni post hoc
tests. Effect sizes are reported as partial eta squared
(ηp2), with cut-off values of 0.01, 0.06 and 0.14 for
small, medium and large effects, respectively
(Cohen, 1988).
In addition to p-values, we have provided a
detailed statistics, including the mean and 95%
confidence interval, in order to best depict the
change within each group between evaluation peri-
ods. Changes in values between moments are
defined as the increase or decrease in values since
evaluation periods. The training effect indicates the
differences between changes in the groups [treat-
ment effect = (ΔExperimental − ΔControl)]. All
analyses were performed using SPSS (version 15.0;
SPSS Inc., Chicago, IL), and the significance level
was set at p ≤ .05 for all tests.
Results
The overall characteristics of the two groups were
similar in terms of age and maturational status.
Within-group analysis for both protocols showed
significant changes only in the internal rotators and
unilateral ratios (Tables I and II). The exception to
this was in the non-dominant shoulder at 3.14 rad s−1,
in which the external rotators also presented signi-
ficant changes from baseline (Table II).
Significant training effects on the internal rotator
strength and unilateral ratios were found for both
shoulders and all procedures. Large effect sizes were
found, as well, in the referred variables for all
evaluation periods (ηp2 > 0.14).
Discussion
In accordance with our findings, a water-training
macrocycle creates imbalances in swimmers’ shoulder

Table I. Comparative water-training effects on the peak torques (Nm) of IR and ER and ER/IR ratios (%) of both shoulders at 1.04 rad s−1

Dominant shoulder − 1.04 rad s−1 Non-dominant shoulder − 1.04 rad s−1

Experimental Control Experimental Control

Baseline
Mean ± SD ER 25.61 ± 4.79 23.20 ± 4.47 24.29 ± 4.72 22.72 ± 4.32
IR 32.50 ± 8.30 24.59 ± 4.75 33.08 ± 10.28 22.73 ± 4.76
Ratio 78.81 ± 15.05 94.35 ± 16.61 73.43 ± 18.63 99.95 ± 14.55
Change to 16 weeks
Mean (95% CI) ER 1.75 (−2.65 to 3.46) 0.52 (−1.89 to 2.01) 1.01 (−0.39 to 2.48) −0.09 (−2.24 to 1.65)
IR 6.47 (2.89 to 9.54)* 0.38 (−1.26 to 3.51) 5.23 (1.09 to 9.01)* 0.28 (−2.26 to 2.89)
Ratio −8.59 (−14.64 to 0.25)* 0.65 (−5.20 to 7.21) −7.37 (−14.21 to 0.26)* −1.64 (−12.02 to 8.24)

p ES p ES

Training effects
Mean (95% CI) ER 1.23 (−1.60 to 4.06) .371 .016 1.11 (−1.52 to 3.74) .401 .015
IR 6.09 (2.73 to 9.44) .001 .437 4.95 (1.20 to 8.70) .011 .443
Ratio −9.24 (−19.43 to 0.21) .005 .386 −5.74 (−12.43 to 2.87) .039 .391

*Significant within-group differences. CI, confidence interval; ES, effect size; ER, external rotation; IR, internal rotation. The p-values are
for differences between groups.
170 N. Batalha et al.

Table II. Comparative water-training effects on the peak torques (Nm) of IR and ER and ER/IR ratios (%) of both shoulders at 3.14 rad s−1

Dominant shoulder − 3.14 rad s−1 Non-dominant shoulder − 3.14 rad s−1

Experimental Control Experimental Control

Baseline
Mean ± SD ER 22.57 ± 4.12 21.84 ± 4.48 21.60 ± 3.79 20.07 ± 3.35
IR 29.92 ± 8.48 22.30 ± 4.73 29.73 ± 8.02 21.51 ± 5.15
Ratio 75.43 ± 14.13 97.94 ± 20.96 73.65 ± 13.59 93.31 ± 20.35
Change to 16 weeks
Mean(95% CI) ER 2.08 (0.46 to 4.35) −0.25 (−1.93 to 2.87) 2.30 (1.09 to 4.22)* 0.52 (−1.91 to 1.98)
IR 5.75 (3.23 to 7.79)* −0.26 (−3.23 to 2.01) 4.00 (2.01 to 6.98)* −0.37 (−2.47 to 1.61)
Ratio −6.34 (−9.28 to −0.56)* 0.01 (−9.02 to 8.59) −4.54 (−9.62 to 0.10)* 0.61 (−8.22 to 10.52)

p ES p ES

Training effects
Mean (95% CI) ER 2.33 (−0.33 to 4.99) .084 .062 1.78 (−059 to 4.11) .129 .048
IR 6.01 (1.96 to 10.06) .004 .476 4.37 (1.74 to 6.99) .013 .340
Ratio −6.35 (−15.34 to 4.65) .025 .360 −5.15 (−13.94 to 5.13) .018 .236

*Significant within-group differences. CI, confidence interval; ES, effect size; ER, external rotation; IR, internal rotation. The p-values are
for differences between groups.

rotator muscles. This confirms the initial theory that,
during an exclusive water-training period, the internal
rotators of competitive swimmers become proportion-
ally stronger when compared with their antagonists,
increasing muscle imbalance and the risk of an injury
process.
It should be noted that our results corroborate
previous findings (Batalha et al., 2012; Dark, Ginn,
& Halaki, 2007). The capacity of internal rotators to
produce force is invariably greater than that of their
antagonists. Overall, these results are no surprise, if
one considers that the muscular groups which
produce the IR of the glenohumeral joint are not
only greater in number but also are anatomically
larger and naturally stronger (Dark et al., 2007).
Regarding changes in strength values throughout
the macrocycle, in the experimental group we
observed an increase in peak torques of both muscle
groups. Similar results were reported by Ramsi et al.
(2004), for three different periods during the season.
However, in our study, the same trend was not
found in the control group.
Despite the fact that the experimental group
showed a progressive increase in strength for both
muscular groups throughout the macrocycle, within-
group analysis only showed significant changes in
internal rotators and unilateral ratios. The only
exception was in the non-dominant shoulder (at
3.14 rad s−1), in which external rotators presented
significant changes from baseline. These results
confirm the idea that aquatic training increases the
internal rotator strength in a disproportionate way in
comparison with their antagonists (Kluemper &
Hazelrigg, 2006; Ramsi et al., 2004). In previous
studies, two main explanations are provided for this.
On the one hand, some studies provide support for
these results on a biomechanical basis, indicating
that internal rotators are more intensely stimulated
due to the repeated concentric contractions to which
they are subjected during swim strokes (Johnson
et al., 2003; O’Donnell, Bowen, & Fossati, 2005;
Yanai & Hay, 2000). On the other hand, O’Donnell
et al. (2005) claim that swimming techniques pro-
mote muscle imbalances which place the glenohum-
eral capsular ligament complex under stress,
contributing to instability of the shoulder joint, with
consequences on the ability to produce force.
For an injury prevention analysis, it should be
remembered that a lack of additional ER strength
increases during the season could predispose the
shoulder to chronic overuse pathologies often asso-
ciated with swimming. The differences in strength
improvements for external rotators are linked to the
role of this musculature during the swim stroke,
which is not for propulsion but for glenohumeral
control (McMaster, Roberts, & Stoddard, 1998).
Regarding shoulder rotator balance, our findings
showed a significant decrease in the experimental
group for both protocols and shoulders, in unilateral
ratios from baseline to 16 weeks, whereas, the
control group had no differences in unilateral ratios
between moments. There are some controversies
among researchers as to whether absolute strength or
strength ratios should be used to quantify optimal
levels of dynamic shoulder stability (Leroux et al.,
1994). However, there is a degree of consensus
regarding unilateral ratios as one of the most
important variables to be characterized when seeking
to diagnose the muscular balance/imbalance of a
given joint (Ellenbecker & Roetert, 2003) and as a

key to understanding injuries and rehabilitation in
competitive swimmers’ shoulders (Blanch, 2004).
The present study clearly demonstrates that swim-
mers’ shoulder rotator imbalances significantly
increase over an exclusive water-training period.
The experimental group data are consistent with
previous data obtained by Ramsi et al. (2004) who
also found significant differences in the unilateral
ratios from baseline to 12 weeks. Additionally, the
effect size analysis for both shoulders revealed mod-
erate to large effects for changes in the unilateral
ratios between moments. However, considering
normative shoulder rotator ratio values (Ellenbecker
& Davies, 2000; Ellenbecker & Roetert, 2003),
despite the decline seen in swimmers, ER/IR ratios
did not register values below 66% at any point,
which according to Leroux et al. (1994) are not
associated with severe imbalances. Notwithstanding
this fact, it should be remembered that lower
shoulder rotator unilateral ratios seem to be related
to future injuries in the shoulder joint (Beach et al.,
1992; Byram et al., 2010).
As a consequence of the different proportionality
of strength gains observed between external and
internal rotators, the analysis of unilateral ratios
showed differences between groups in terms of
training effects in both shoulders and for all proto-
cols, revealing moderate to large effect sizes. Our
findings are in keeping with those of Olivier et al.
(2008), who stated that swimmer shoulder unilateral
ratios are significantly lower than those of non-
swimmers.
We acknowledge certain limitations to our study.
Isokinetic testing was performed with subjects in a
non-swimming-specific position. A prone testing
position may be more suitable for swimmers; how-
ever, this option was not available with our assess-
ment tool. Another limitation is related to the
characteristics of subjects belonging to the experi-
mental group. Due to their similarity in age and
competitive level, care should be taken in applying
these findings to groups of swimmers with other
characteristics.
Conclusions
A water-training macrocycle promotes imbalances in
swimmers’ shoulder rotator muscles. This is a
consequence of the fact that internal rotators shoul-
der muscles become proportionally stronger as
compared with their antagonist group, increasing
the agonist–antagonist muscle imbalance. Since the
decrease in shoulder rotator unilateral ratios seems
to be related to future chronic upper extremity
overuse injury, we recommend that coaches use
land-based preventive strength-training protocols
with competitive swimmers, focusing specifically on
Shoulder rotator balance in young swimmers 171
external rotator muscles and stabilizers of the shoul-
der joint.
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